Preview
Diagnosis, treatment, and prognosis have long been recognized as the three great clinical skills in medicine( 1 ). Prior to the turn of the 20th century, prognosis was more prominent than today because few effective treatments were available. Over the past 100 years, prognosis gradually gave way to treatment as the core clinical skill accompanying diagnosis: increasingly successful therapies made details of the natural history of illness progression become less relevant to the clinician( 2 ).
The growth of palliative medicine led to a renaissance of prognostication as a clinical skill. But unlike in the 19th century when prognosis most often involved acute illness in young adults, in contemporary palliative medicine prognosis relates to chronic progressive and ultimately fatal diseases and co-morbidities across all age groups.
Palliative care clinicians need to be proficient at prognosis for various reasons:
While some of these reasons are relevant before referral to palliative care services (e.g. eligibility criteria), others become more relevant after referral. A key role for palliative care services is to initiate discussions on prognosis and goals of care( 12 ), as these are often neglected prior to the consultation( 13 ). An audit of 325 consecutive referrals to a palliative care service in a US academic teaching hospital indicated that discussions on prognosis and goals of care were the most common function performed by the service, occurring in almost 95 per cent of cases( 14 ).
Chapter. 30360 words. Illustrated.
Subjects: palliative medicine ; medical statistics and methodology
Go to Oxford Medicine Online » abstract
full text: subscription required